A tumor can be viewed as an aberrant organ initiated by a tumorigenic cancer cell that acquired the capacity for indefinite proliferation through accumulated mutations. In this view of a tumor as an abnormal organ, the principles of normal stem cell biology can be applied to better understand how tumors develop and disseminate. Many observations suggest that analogies between normal stem cells and tumorigenic cells are appropriate. Both normal stem cells and tumorigenic cells have extensive proliferative potential and the ability to give rise to new (normal or abnormal) tissues. Tumorigenic cells can be thought of as cancer stem cells (CSC) that undergo an aberrant and poorly regulated process of organogenesis analogous to what normal stem cells do. Both tumors and normal tissues are composed of heterogeneous combinations of cells, with different phenotypic characteristics and different proliferative potentials.
Cancer stem cells are believed to be a small fraction of tumor cells with stem cell-like properties, which initiate and maintain neoplastic clones. These cells have the ability to self-renew, but also give rise to progenitors that yield phenotypically diverse cancer cells but with lower tumorigenic potential. This subpopulation of stem-like cells should be highly efficient at tumor formation as compared to tumor cells that are not cancer stem cells.
Cancer stem cells (CSCs) have now been identified in a wide variety of cancers including glioblastomas, medulloblastomas, colon, liver, lung, prostate, breast and ovarian tumors. While CSCs do not necessarily arise from normal stem cells, they have frequently been isolated by using markers found in normal stem cells. For example, the marker CD133 has been used to identify normal adult hematopoietic and neural stem cells. CD133 has now been successfully used to enrich for CSCs from glioblastoma, medulloblastoma, colon and prostate tumors.
The presence of cancer stem cells has profound implications for cancer therapy. At present, all of the phenotypically diverse cancer cells in a tumor are treated as though they have unlimited proliferative potential and can acquire the ability to metastasize. For many years, however, it has been recognized that small numbers of disseminated cancer cells can be detected at sites distant from primary tumors in patients that never manifest metastatic disease. One possibility is that most cancer cells lack the ability to form a new tumor such, that only the dissemination of rare cancer stem cells can lead to metastatic disease. Hence, the goal of therapy must be to identify and kill this cancer stem cell population.
Existing therapies have been developed largely against the bulk population of tumor cells, because the therapies are identified by their ability to shrink the tumor mass. However, because most cells within a cancer have limited proliferative potential, an ability to shrink a tumor mainly reflects an ability to kill these cells. Therapies that are more specifically directed against cancer stem cells may result in more durable responses and cures of metastatic tumors.
It is highly desirable to be able to identify these cancer stem cells using specific markers, and then use these markers to develop cancer stem cell specific therapeutics. In particular, despite advances in our understanding, the overall median survival for glioblastoma multiforme (GBM) remains at 11-13 months with almost 100% recurrence. The present invention addresses this issue.